Investigators found that fragmented care may be more prevalent among patients with pancreatic adenocarcinoma who receive single-modality neoadjuvant therapy compared with those who receive total neoadjuvant therapy, according to findings presented by Taylor et al during Digestive Disease Week (DDW) 2024 (Abstract 829).
Background
Neoadjuvant therapy may include chemotherapy or radiation therapy either alone or in combination. Patients treated with single-modality neoadjuvant therapy receive either chemotherapy or chemoradiation prior to surgery, whereas those treated with total neoadjuvant therapy receive both chemotherapy and chemoradiation prior to surgery. Fragmented care involves receiving treatment at multiple centers.
“There are so many human factors at play from the point of diagnosis through treatment. [Patients] with pancreatic cancer may be diagnosed at a different location than where they receive chemotherapy/radiation, and that may be a different location than where they undergo surgery,” stressed lead study author Maryclare Taylor, MD, a general surgery resident at Temple University Hospital. “We wanted to look into how this fragmentation of care affects patient outcomes and how sociodemographic factors come into play,” she added.
Study Methods and Results
In this study, the investigators examined a cohort of 256 patients with pancreatic adenocarcinoma who received neoadjuvant therapy—with the goal of determining whether sociodemographic disparities may help predict which patients received fragmented care. They noted that predictors of care included age at diagnosis, race and ethnicity, and median household income. The investigators also assessed patients’ social vulnerability index scores, which are used by the U.S. Centers for Disease Control and Prevention to measure socioeconomic status, household characteristics, minority status, and housing and transportation.
The investigators found that 44.9% of the patients (n = 115) received neoadjuvant therapy—25.2% (n = 29) of whom were treated with single-modality neoadjuvant therapy, and 74.8% (n = 86) of whom were treated with total neoadjuvant therapy. They identified no statistically significant differences in median age, race and ethnicity, median household income, and social vulnerability index scores between the single-modality and total neoadjuvant therapy groups. However, the investigators demonstrated that the patients who received single-modality neoadjuvant therapy were more likely to experience fragmentation of care compared with those who received total neoadjuvant therapy (72% vs 48%, respectively).
“Among the [single-modality neoadjuvant therapy] cohort, [the social vulnerability index] score was higher among patients who experienced fragmented care—indicating a higher level of vulnerability per county in the [single-modality neoadjuvant therapy cohort] who received fragmented care,” Dr. Taylor detailed.
Conclusions
“Recognizing how sociodemographic disparities impact fragmentation of care is pivotal in the understanding of how this newly emerging concept of fragmented care affects [patients with] cancer,” she concluded.
Disclosure: For full disclosures of the study authors, visit meetings.ssat.com.
